Medical Treatment of Parkinson's Disease

Levodopa/carbidopa (Sinemet) is the most effective medication in terms of improving the motor symptoms associated with Parkinson's disease. However due to the frequent, and sometimes serious side effects of this drug, neurologists prefer trying other medications first. Unfortunately, the medications available [bromocriptine (Parlodel), pergolide (Permax), pramipexole (Mirapex) and ropinirole (Requip)] are not as good as levodopa/carbidopa in the control of the motor symptoms and also have some side effects that limit their use.

Selegiline (Eldepryl, Deprenyl) a medication that does not have any major effects on the motor symptoms, might be the only medication with some protective effect of the nerve cells, but this is not yet well proven. The other medications are only used to treat the symptoms.

Surgical Treatment of Parkinson's Disease

In the hands of experienced surgeons operations like thalamotomy and pallidotomy, that excise some areas of the brain related to the persistence of the motor disorder might be indicated. In general, very few selected cases are candidates for surgery, mostly individuals with disabling unilateral movement disorder that is resistant to medication.

Deep brain stimulation with electrodes implanted in the brain is a surgical technique that does not require ablation of the brain and might also be useful in selective cases.

The indications for surgery are limited, and surgery should be done after carefully considering both the benefits and side effects of the surgery.

Transplantation of neurons in the brain to restore the dying cells is an interesting approach; however, this method is still in the experimental phase.

Enhanced Physiologic Tremor

In cases in which the tremor is associated with a specific disease, the tremor improves with the treatment of the condition. When anxiety is the only problem or no other cause is found, then propranolol (Inderal, Inderal LA) or clonazepam (Klonopin) could be effective.

Follow-up for Tremors

Just as the selection of the most appropriate treatment depends on the cause of the tremor and should be done by a physician who is an expert in the diagnosis and treatment of these conditions, the same principle applies for the follow-up. Depending upon the cause, follow-up may be very stringent and intense.

Tremors Prevention

In conditions in which there is a genetic base, as in the case of the familial form of essential tremor or as could also be the case in Parkinson's disease, there is not much that can be done for the prevention of the condition.

In other instances, such as the case of industrial or accidental exposure to toxins, prevention is possible with education and industrial precautions. One of the best examples available is the prevention of lead intoxication in children which used to be common and now, through continuous monitoring of blood levels of lead from early life, is rarely seen.

Medically reviewed by Joseph Carcione, DO; American board of Psychiatry and Neurology

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